Healthcare Provider Details

I. General information

NPI: 1982609525
Provider Name (Legal Business Name): STEPHANIE CHRISTINE LILLIS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 20TH ST NW
STEWARTVILLE MN
55976-1003
US

IV. Provider business mailing address

100 20TH ST NW
STEWARTVILLE MN
55976-1003
US

V. Phone/Fax

Practice location:
  • Phone: 507-533-4777
  • Fax: 507-533-4778
Mailing address:
  • Phone: 507-533-4777
  • Fax: 507-533-4778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4424
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: